MEDICARE: TYRON REECE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A31509	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629127170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRON REECE M.D.

Provider Business Mailing Address
First Line	:	301 N PRAIRIE AVE
Second Line	:	230
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-4507
Country	:	US
Telephone Number	:	310-330-0240
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N PRAIRIE AVE
Second Line	:	230
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-4507
Country	:	US
Telephone Number	:	310-330-0240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/09/2007

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